Surgical procedures require correct identification of exposed anatomy with concomitant localization amidst contiguous structures. In endoscopic procedures the surgeon is provided a real-time endoscopic view and is prepared with radiologic images. Here we present an overview of a methodology of localization using intraoperatively acquired magnetic resonance (MR) images in preparation for magnetic resonance imaging-guided endoscopic sinus surgery. The methodology centers around a unique prototype imaging device and operating environment. An 'open' 0.5 Tesla MR unit has been created that allows complete access to the patient's head and neck while concomitant images are obtained. Illustrative examples of the localization technique from cadaver experiments are presented, as well as insights into the host of concerns for anesthesia, equipment, surgical instrumentation, communications, and documentation.
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